tbuckley/cabot-search huggingface dataset:
Abstract 14772: Comparing Efficacy of Venous Closure Devices in Patients Undergoing Atrial Fibrillation and Atrial Flutter Ablation: A Retrospective Review
Authors: Adnan Ahmed, Jalaj Garg, Rishi Charate, Naga Venkata K Pothineni, Rakesh Gopinathannair, Andrea Natale, Dhanunjaya Lakkireddy
Journal: Circulation (2022)

Introduction: Vascular closure devices have shown marked improvement in patient comfort and time to ambulation after undergoing atrial fibrillation (AF) and atrial flutter (AFL) radiofrequency ablation. They have been proven superior to manual closure and Figure of 8 suture in terms of pain control and time to ambulate. However, data comparing different vascular closure devices is sparse. Hypothesis: To compare the efficacy of venous closure devices Methods: We retrospectively reviewed 100 patients at our institution who underwent AF and AFL radiofrequency ablation. We aimed to assess the difference in time to ambulation, device failure, pain control and vascular complication rate between the two commonly used venous closure devices (VASCADE and PERCLOSE). Results: A total of 100 patients (50 in each arm) were included in the study. The mean age was 67.6 + 9.3 years and 73% patients were men. The two groups were well balanced with respect to baseline demographics and clinical characteristics except for coronary artery disease (24% VASCADE vs. 14% PERCLOSE, p &lt;0.001). No significant difference was observed in time to ambulate between PERCLOSE (2 + 0.21 hours) vs VASCADE (2 + 0.23 hours); p=0.74. 8% patients (n=4) in VASCADE arm required additional PERCLOSE to achieve hemostasis. 4% (n=2) patients in PERCLOSE arm required opioids for pain management; compared to none in VASCADE arm. No closure device related complications were observed in either arm. Conclusions: Both venous vascular closure systems offer similar efficacy in terms of time to ambulate. However, PERCLOSE was used in addition to VASCADE in a few instances to achieve hemostasis.
Abstract 14045: Implementation of High-Sensitivity Cardiac Troponin Assay in Emergency Department Increases Myocardial Infarction Diagnosis and Utilization of Invasive Cardiac Procedures: An Insight From Middle East/ Gulf Region
Authors: NOUR DABABO, Nada almahmeed, Ahmad Edris, Laila AbdelWareth, Yosef Manla, Terrence Lee St John, Firas Al Badarin
Journal: Circulation (2022)

Introduction: Utilization of high-sensitivity cardiac troponin T (hsT) assays facilitates evaluation of patients with suspected acute coronary syndrome in emergency department (ED) by expediting clinical-decision making and disposition. While the utility of (hsT) has been previously shown, data from the Middle East/ Gulf region (MEG) are limited. We aimed to evaluate the association between hsT implementation and changes in resource use at a tertiary care center in MEG. Methods: Consecutive patients evaluated in ED using hsT (hsT era) or conventional troponin assays (pre-hsT era) were identified. Discharge diagnosis of myocardial infarction (MI), utilization of invasive and non-invasive testing (cardiac CT, perfusion imaging and stress echocardiography) during index admission was determined using ICD codes. Unadjusted rates of these outcomes in addition to in-hospital mortality were compared before and after adoption of hsT assays using appropriate tests. Results: Among 21,149 and 18,979 ED encounters before and after implementation hsT, mean patient age was 53.8 ± 18.1 and 53.3 ±17.8, (P=.09), respectively. The introduction of hsT assay was associated with a 23% increase in MI diagnosis (3.7% vs 3.0%; P&lt;.001), 13% increase in invasive angiography use (4.4% vs. 3.9%; P=.02), and a concomitant 70% reduction in use of non-invasive studies (0.02% vs. 0.07%; P=.02). Additionally, mortality during index admission was significantly higher in the hsT era (1.3% vs. 1.1%; P=.01). Conclusion: Introduction of hsT assay at a single-center in MEG increased MI diagnosis and identified patients who are at increased risk of death. Furthermore, it was associated with greater use of invasive cardiac procedures. Whether more aggressive management during index hospitalization in this population is associated with favorable long-term outcomes requires additional studies.
Abstract 14071: Sleep as a Contributor to Socioeconomic Disparities in Hypertension: The Midlife in the United States (MIDUS) II Study
Authors: Jasmine K Aqua, Olivia Barnum, Dayna A Johnson
Journal: Circulation (2022)

Introduction: Hypertension is highly prevalent among adults in the United States and is a major risk factor for cardiovascular disease (CVD). Previous research has found that hypertension is distributed inequitably, with a higher burden of hypertension among individuals of lower socioeconomic status (SES). However, limited studies have investigated the role of sleep quality, a risk factor for CVD, in understanding socioeconomic disparities in hypertension. Methods: We used cross-sectional data from the Midlife in the United States (MIDUS) II. Participants underwent seven days of actigraphy and completed biological assessments, including blood pressure measurements. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Our analysis consisted of participants with complete data on educational attainment, our proxy for SES (n=426). Poisson and linear regression models were fit to examine associations between SES, sleep quality, and hypertension or blood pressure (continuous). We controlled for age, gender, race, body mass index, and perceived stress. Sensitivity analyses measuring SES with the Socioeconomic Index Score were also conducted (n=274). Results: Participants had a mean age of 53.5 years (SD=12.4), were 59.6% female, and were 42.5% Black American. The prevalence of poor WASO (&gt; 30 minutes), low SE (&lt;85%), and hypertension was 77.7%, 67.1%, and 61.0%, respectively. Low SES was associated with a higher prevalence of hypertension but was attenuated after adjustment for race. SES was not associated with sleep or hypertension after adjustment for covariates. Individuals with high (vs. low) sleep efficiency had 19% lower prevalence of hypertension (PR=0.81, 95% CI: 0.66, 0.98), lower systolic blood pressure (β= -4.69, 95% CI: -8.63, -0.75), and lower diastolic blood pressure (β= -2.59, 95% CI: -5.00, 0.18) after adjustment for covariates. There was no evidence of sleep mediating the SES-hypertension relation. Conclusions: Effective interventions to lower the prevalence of hypertension should consider strategies that target sleep efficiency. Future research should explore the intersectionality of SES and race, as race may modify the association between SES and hypertension.
Abstract 14021: A Meta Analysis for Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients With Bicuspid versus Tricuspid Aortic Valves Using Balloon Expandable versus Self Expanding Valves
Authors: Enhua Wang, Yasser Radwan, Mohammad F Salam, Khalid Saeed Al-Asad, Adnan Halboni, Abdullah Al-abcha, Yehia Saleh, Abela George
Journal: Circulation (2022)

Introduction: Over the past decade, several next generation transcatheter aortic valve replacement (TAVR) devices have been developed with the aim of improving patients’ outcomes. Bicuspid aortic valves (BAVs) are an emerging issue in TAVR practice. The goal of this study was to compare clinical outcomes of TAVR using balloon-expandable (BE) versus self-expanding (SE) transcatheter heart valves in patients with BAV vs tricuspid aortic valve (TAV). Methods: We searched PubMed, Cochrane and Embase databases systematically for relevant studies from inception to March 2022. The primary focus was 1-year all-cause mortality. Additional outcomes included short term (30-days) all-cause mortality, cardiovascular mortality, stroke, major/life threatening bleeding, permanent pacemaker (PPM) implantation and major vascular complications. Results: There were 28 studies with a total 346,033 patients who underwent TAVR, 17,835 of which had BAV stenosis. In the BE group, there was a statistically lower risk of mortality of TAVR in the BAV when compared to the TAV (OR 0.69 [95% CI 0.49-0.97]; p=0.03). In terms of short-term outcomes of BE group, the risks of all-cause mortality, stroke, PPM implantation, major bleeding, and major vascular complications were all similar between the two arms. In the SE group, there were not statistically significant in the clinical outcomes between patients in BAV and TAV. Conclusions: The use of balloon-expandable valves in TAVR was associated with a lower risk of 1-year mortality in patients with BAV compared to patients with TAV. These data support the need for a randomized trial to compare the balloon-expandable valves in BAV patients.
Abstract 13113: Health-Related Quality of Life After Neonatal Treatment of Symptomatic Tetralogy of Fallot: Insights From the Congenital Cardiac Research Collaborative
Authors: Jeffrey D Zampi, George T Nicholson, Bryan H Goldstein, Andrew C Glatz, Christopher J Petit, Courtney E McCracken, Athar M Qureshi, Caren S Goldberg, Jennifer C Romano, Mark A Law, Jeffery J Meadows, Shabana Shahanavaz, Sarosh P Batlivala, Shiraz A Maskatia, Joelle A Pettus, Asaad Beshish, Kathryn O Stack, Hala Q Khan, Shalin Parekh, Dawn L Ilardi
Journal: Circulation (2022)

Introduction: Health-related quality of life (HRQOL) is impaired for patients with chronic illnesses and critical congenital heart disease (cCHD). For symptomatic neonates with tetralogy of Fallot who require neonatal intervention (sTOF), existing studies are limited but suggest early surgical management and ongoing disease burden negatively impact HRQOL. The current study aims to explore HRQOL in sTOF patients after primary repair (PR) vs. staged repair (SR; initial palliation with subsequent complete repair). Methods: The Pediatric Quality of Life Inventory (PedsQL) was used to assess HRQOL. Age-appropriate PedsQL modules and a parent survey were sent to all living sTOF patients with neonatal intervention from 2005-2017 across 9 centers. These were compared to established population data from children who are healthy, have chronic illness, and have cCHD. Differences in patient and clinical factors were compared between those with normal and low (&gt;2 standard deviations below the mean) HRQOL scores. Results: Of 511 surveys sent, 143 were returned (28%). Of the respondents (53% male, age 3.2-15.9 years), PedsQL scores were lower than the healthy population (total score 75 vs 84, p&lt;0.001) but similar to patients with chronic illnesses (74, p=0.64) and cCHD (76, p=0.72). Although only 7% and 2% of parents rated their child’s overall health and QOL as fair or poor, up to 27% of patients had PedsQL scores &gt;2 SD below the healthy population mean. Factors associated with low HRQOL included longer duration of inhalational anesthetic exposure within 18 months of life (p=0.04) and any hospital complications after index procedure (p=0.01). There was no association between HRQOL and initial treatment strategy (PR vs SR, p=0.9). Conclusions: Lower HRQOL in sTOF is consistent with those with chronic illnesses and other forms of severe CHD. Initial treatment strategy was not associated with differences in HRQOL in sTOF patients so future comparison to other CHD groups, including non-cyanotic TOF patients, may help elucidate drivers of lower HRQOL. The discrepancy between parental description of QOL and standardized measurement of QOL is striking, warranting further investigation of parental expectations and potential impact on health resource utilization.
Abstract 14068: Reduced Left Atrial Conduction Velocity in Patients With Hypertrophic Cardiomyopathy and Normal Left Atrial Voltage Presenting for Paroxysmal Atrial Fibrillation Ablation
Authors: Sohail Zahid, Tahir Malik, Connor Peterson, Matthew Dai, Moshe Katz, Scott Bernstein, Chirag Barbhaiya, David S Park, Robert Knotts, Douglas Holmes, Alexander Kushnir, Anthony Aizer, LARRY A CHINITZ, Lior Jankelson
Journal: Circulation (2022)

Introduction: Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement characterized as myocardial disarray. The incidence of atrial fibrillation (AF) is increased 4-fold in patient with HCM and confers a 4-fold increased risk of death. Catheter ablation is less effective in HCM, with a 2-fold increased risk of AF recurrence. The mechanisms of AF perpetuation and recurrence in HCM are poorly understood. We sought to investigate the left atrial conduction characteristics in patients with HCM, paroxysmal AF and normal left atrial bipolar voltage. Methods: We analyzed 24 consecutive patients with HCM and 24 consecutive controls, all presenting for radiofrequency (RF) ablation of paroxysmal atrial fibrillation. Only patients with normal left atrial voltage (mean voltage &gt;0.8 mV) were included in the study. Intracardiac electrograms were extracted from CARTO (Biosense Webster Inc.) mapping system and analyzed using custom Matlab/Python code interfacing with Core OpenEP software. Conduction velocity was calculated using local activation time gradients. Results: There was no difference in baseline demographic characteristics or atrial size measured by echocardiography between HCM and control patients. Patients with HCM had significantly reduced atrial conduction velocity and conduction velocity dispersion compared to controls (Fig A,C) [0.62±0.03 m/s vs 0.44±0.04 m/s, p=0.002], despite no differences in bipolar voltage (Fig B,D) or voltage dispersion. Patients with HCM had significantly less freedom from AF than controls after catheter ablation [OR for recurrence 3.3 (1.02-10.90), p&lt;0.05 vs control]. Conclusion: Atrial conduction velocity and dispersion is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia perpetuation and persistence after catheter ablation. This finding may be useful in characterizing left atrial properties beyond bipolar voltage.
Abstract 14259: Novel Long Noncoding RNA, <i>Ppp1r1b-LncRNA</i> , Epigenetically Promotes Myogenic Differentiation Program in Cardiac and Skeletal Myocytes
Authors: Xuedong Kang, Yan Zhao, Marlin Touma
Journal: Circulation (2022)

Introduction: Emerged as critical regulators of the transcriptome, the lncRNAs play important roles in cardiac development and might be targeted to treat human cardiomyocyte dysfunction in congenital heart disease. In our work, we identified a novel lncRNA, Ppp1r1b-lncRNA , as an essential, functionally conserved, positive regulator of myogenic differentiation. Hypothesis: Ppp1r1b-lncRNA promotes myogenic differentiation program of cardiac and skeletal myocytes via epigenic mechanisms. Methods: Antisense oligonucleotides (GapmeR) were used to suppress Ppp1r1b-lncRNA . Chromatin immunoprecipitation (CHIP) and chromatin isolation by RNA purification (CHIRP) were used to analyze gene specific histone modification level and lncRNA: chromatin interaction, respectively. RNA pull-down and RNA immunoprecipitation (RIP) were used to identify Ppp1r1b-lncRNA : protein interactome. Results: By silencing Ppp1r1b-lncRNA, skeletal myoblasts and human-induced pluripotent stem cell derived cardiomyocytes (hiPSCs-CMs) failed to develop fully differentiated myotubes. Analysis of GapmeR injected neonatal mouse heart further confirmed the role of Ppp1r1b-lncRNA in normal myogenesis. Members of muscle specific transcription factors, including MyoD1 and TBX5, were not induced during myogenic differentiation in the Ppp1r1b-lncRNA depleted cardiac and skeletal muscle precursor cells. Histone modification analysis revealed enrichment of H3K27 tri-methylation at MyoD1 and TBX5 promoters in GapmeR treated skeletal myoblasts. Furthermore, Ppp1r1b-lncRNA was found to bind to Ezh2, and ChIRP analysis revealed enriched interaction of Ppp1r1b-lncRNA with Myod1 and Tbx5 promoters, suggesting that Ppp1r1b-lncRNA induces transcription of myogenic regulatory factors by interacting with the polycomb repressive complex 2 (PRC2) at the chromatin interface. Correspondingly, the silencing of Ppp1r1b-lncRNA increased EZH2 binding at promoter regions of myogenic transcription factors. Conclusions: Ppp1r1b-lncRNA promotes myogenic differentiation by inhibiting histone methylation on the promotors of myogenic master regulators via competing for PRC2 binding with chromatin during heart and skeletal muscle development.
Abstract 12761: Association of Androgen Deprivation Therapy With Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis
Authors: Justin D Swaby, Ankita Aggarwal, Akshee Batra, Anubhav Jain, Lakshya Seth, Nickolas Stabellini, Zachary Klaassen, Pedro Barata, Nicolas Sayegh, Neeraj Agarwal, Martha Terris, Avirup Guha
Journal: Circulation (2022)

Introduction: Androgen deprivation therapy (ADT), a backbone treatment for advanced prostate cancer (PC) is known to have a variety of metabolic side effects. We conducted an updated meta-analysis to quantify metabolic risks of ADT. Hypothesis: We hypothesized that ADT would increase the risk for metabolic diseases compared to PC patients not on ADT. Methods: We searched PubMed, Web of Science, and Scopus in May of 2022 for studies that investigated the risk of metabolic syndrome (MetS), diabetes, and hypertension from ADT in PC patients using keywords. 4 blinded reviewers screened studies. Only studies that had a comparison group of PC patients not on ADT were included. For included studies, relative risk (RR) was pooled using a random effects model. Results: 1846 records were screened, of which 19 were found suitable for data extraction (Figure 1). 5 studies including 831 patients had MetS as an outcome, with the random effects model showing a pooled RR of 1.49 ([95% Confidence Interval (CI), 1.01-2.21]; I 2 =59%: p=0.04) for patients on ADT. 12 studies including 409,490 patients examined diabetes as an outcome, and the random effects model showed a RR of 1.40 (95% CI, 1.28-1.54), while 4 studies including 7,051 patients examined hypertension as an outcome, and the random effects model showed a RR of 1.30 (95% CI, 1.08-1.55) in ADT patients. Conclusions: ADT was shown to increase the risk of MetS, diabetes, and hypertension in patients with PC undergoing ADT compared to PC patients not on ADT. These results should be understood in the context of collaboration between a patient’s oncologist and primary care provider to optimize care.
Abstract 12883: Trends in Clinical Characteristics and Mortality in STEMI Patients Over Two Decades: Insights From the Midwest STEMI Consortium
Authors: Mehmet Yildiz, Divya Kompella, Brynn Okeson, Kirtan Patel, Madison Pico, Jenny Chambers, Frank Aguirre, Dalia Aziz, Ross Garberich, James Jollis, Santiago A Garcia, Scott W Sharkey, Timothy D Henry, ODAYME QUESADA
Journal: Circulation (2022)

Introduction: The past two decades have witnessed the evolution of percutaneous intervention technologies, advancements in post-STEMI cardiac care, and initiatives to improve STEMI systems of care. We aimed to explore the impact on STEMI management and prognosis in well-established regional STEMI systems. Methods: We examined the trends in clinical characteristics, management, and mortality in 12,879 consecutive STEMI patients between the periods of 2003-2009 (n=4,159) and 2010-2020 (n=8,720) using the Midwest STEMI Consortium; which consists of regional and tertiary STEMI centers with standardized STEMI protocols. Results: In 2010-2020, patients were older, more frequently female, and with a higher prevalence of previous MI, hypertension, dyslipidemia, and diabetes compared with the 2003-2009 period. In 2010-2020, patients were more likely to be treated with PCI, had shorter reperfusion times, and were more likely to receive guideline-directed medical therapy (GDMT) at discharge. Out-of-hospital cardiac arrest (OHCA) was more frequent in the 2010-2020 period (8.7% vs 10%, p=0.025), while the rate of cardiogenic shock was similar. In-hospital mortality was higher in the 2010-2020 period (4.7% vs 5.6%, p=0.037); while the post-discharge to 1-year mortality was lower (5.8% vs 4.4%, p=0.053) (Table). Conclusions: In a well-established consortium of regional STEMI systems, the patient population has become at higher risk but STEMI management has improved with higher PCI rates, lower reperfusion time, and higher rates of GDMT, leading to lower post-discharge to 1-year mortality risk. In-hospital mortality risk was higher in the 2010-2020 period likely related to a higher cardiovascular risk profile, in particular, the increased number of OHCA in the last decade.
Abstract 13161: Longitudinal Profiling of Fasting Plasma Metabolome in Response to Weight-Loss Interventions in Patients With Morbid Obesity
Authors: Mingjing Chen, Zhiguang Huo, Hao Peng, Guanhong Miao, Xiaoxiao Wen, Stephen Anton, Gang Hu, Ricky Brock, Phillip J Brantley, Jinying Zhao
Journal: Circulation (2022)

Background: The mechanisms underlying the favorable effects of Roux-en-Y gastric bypass (RYGB) over adjustable gastric banding (BAND) or non-surgical interventions on long-term metabolic outcomes remain largely unknown. Studies to date have largely been cross-sectional in nature and confounded by weight loss. Objective: Identify plasma metabolites associated with differential metabolic outcomes in response to different types of weight-loss interventions, independent of weight loss. Methods: We studied 75 patients with obesity (25 each in RYGB, BAND, or intensive medical intervention [IMI]) in the HeadsUp Study, a longitudinal study designed to evaluate the effectiveness of different weight-loss interventions. Using untargeted metabolomics (GC-TOF-MS), we repeatedly measured 364 metabolites (153 known) in fasting plasma samples collected at baseline and 1-year after intervention. Linear regression model was used to identify baseline metabolites predictive of changes in fasting plasma glucose (FPG) and HbA1c, adjusting for age, sex, BMI, FPG, or HbA1c at baseline and weight loss. Longitudinal associations were examined with linear mixed-effect models, adjusting for same covariates plus change in BMI and weight loss. Metabolites enrichment and network analyses were performed to identify related metabolic pathways. Results: We identified 41 baseline metabolites (18 known) significantly predictive of changes in FPG or HbA1c when comparing RYGB vs. IMI. Longitudinal changes in 37 metabolites (22 known) and 76 metabolites (32 known) were significantly associated with changes in FPG or HbA1c when comparing RYGB vs. IMI, and RYGB vs. BAND, respectively. The identified metabolites are enriched in pathways involved in aminoacyl-tRNA and branched chain amino acids (BCAAs) biosynthesis. Conclusion: Baseline plasma metabolites predict differential metabolic outcomes induced by different types of weight-loss interventions, with the effects being independent of weight loss. Our findings suggest that RYGB may exert its favorable metabolic effects via rewiring metabolism, and help identify patients who may obtain the greatest benefits from bariatric surgery.